Strategic Plan Stop TB Working Group on DOTSPlus for MDRTB Meeting of the Steering Committee for the

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Strategic Plan Stop TB Working Group on
DOTS-Plus for MDR-TBMeeting of the Steering
Committee for the Global Plan to Stop TB
(2006-2015) Addis Ababa, 2 May 2005Thelma E.
Tupasi, MD, Acting Chair
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Process for developing the strategic plan

• Planning workshop in Montreux, March 2005
  discussions on epidemiological scenarios with
• DOTS-Expansion Working Group
• Laboratory strengthening subgroup
• Diagnostic Working Group
• Telephone conferences with WHO Regional Offices
  on epidemiological scenarios
• Discussion on epidemiological scenarios, cost and
  impact at ad hoc DOTS-Plus strategy meeting,
  18-19 April 2005

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MDR-TB control political and technical momentum

• Expanded DOTS Framework 2002
• GFATM and GLC agreement 2002
• 2nd ad hoc Committee on the TB Epidemic 2003
• EB 2004 and WHA 2005
• Revised WHO treatment guidelines
• New vision of TB control
• International Standards of TB care
• New DOTS-Plus guidelines
• Rapid expansion of DOTS-Plus as routine
  components of TB control

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Vision 2006-2015

• Drug resistance surveillance and DOTS-Plus
  integrated as routine components of TB control
  providing access to diagnosis and treatment for
  all TB patients and by all health care providers.

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Objectives

• Espansion of DRSData on the global magnitude and
  trends of MDR-TB, and on the relationship between
  MDR-TB and HIV/AIDS
• Expansion of DST
• Adequate treatment of all detected MDR-TB
  patients
• Quality-assured 2nd-line drug production in high
  MDR-TB burden countries and further reduction of
  prices of second-line drugs
• Global coordination, collaboration and management

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DST expansion

• By 2015
• Globally, all previously treated cases
• Eastern Europe, also all new cases
• Latin America, Southeast Asia and Western
  Pacific, also 20 of targeted new cases

Example of DST expansion - Western Pacific Region
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DOTS-Plus expansion

• By 2015 Treatment with quality-assured 2nd-line
  drugs to all detected MDR-TB patients following
  WHO guidelines
• Estimated number of culture-positive MDR-TB
  patients under DOTS-Plus
• 2005 4
• 2010 24
• 2015 66
• Almost 1 million MDR-TB patients treated under
  DOTS-Plus, 2006-2015

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DOTS-Plus expansion Eastern Europe
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MDR-TB patients to be treated per year under
DOTS-Plus
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Total MDR-TB patients to be treated under
DOTS-Plus (thousands)
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Cost per MDR-TB patient treated
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Resources neededDOTS-Plus country activity costs
2006-2015
Total US 5,3 billion
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Resources neededDOTS-Plus global coordination
costs, 2006-2015, 60 millions
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Impact

• DOTS-Plus impact
• 895,000 MDR-TB patients receiving adequate
  treatment
• 660,000 MDR-TB patient successfully treated
• Half a million MDR-TB deaths averted
• DOTS/DOTS-Plus impact
• Reduction in previously treated patients from
  19 to 15 of all confirmed TB cases
• Decrease in MDR-TB prevalence by 50

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Monitoring and evaluation

• Future
• Epidemiology and DOTS-Plus performance
• DOTS-Plus recording and reporting included in
  DOTS
• MDR-TB notifications and DOTS-Plus outcomes part
  of Global Tuberculosis Control Report
• TA provided as one package (DOTS/DOTS-Plus)

• Current
• Epidemiology WHO/IUATLD DRS project
• Laboratory performance SNRL and NRL
• DOTS-Plus performance GLC and WHO
• 2nd-line drug use Inventory of public and
  private sector drug usePre-qualification project
• Global coordination activities and costsWorking
  Group

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Key risk factors

• Lack of political will
• Misuse and low quality of second-line drugs
  resulting in the creation of strains resistant to
  all known anti-TB drugs
• MDR-TB and HIV/AIDS
• Qualified human resources
• Financial resources
• Public health infrastructure (especially
  laboratory capacity)
• Organization and management of health care
  delivery